Pediatric Coding Alert

Question: While I was performing a scheduled preventive medicine service for a child, the mother said, "By the way, my other child is pulling at her ears." I took a peek at the sibling's ear. Should I charge for the second service?


California Subscriber


Answer: Absolutely. Looking at the second child's ear probably also involved pulling her chart and completing an encounter form. All of these actions indicate that you performed an E/M service, albeit one that was unscheduled.

Remember: Although performing a "by the way" service may be good PR, you aren't obligated to disrupt your schedule to do this. It's OK to ask the mother to come back later for the other child.

You would certainly charge for such a separately scheduled service, so you should treat the additional exam at the time of another patient's scheduled appointment the same way: Document and bill the history, examination and medical decision-making.

Assign the appropriate-level office visit code (such as 99212 or CPT 99213 , Office or other outpatient visit for the evaluation and management of an established patient) and collect the designated copay, such as $25, in addition to the scheduled preventive medicine service for the other child (for instance 99392, Periodic comprehensive preventive medicine re-evaluation and management of an individual ...; early childhood [age 1 through 4 years]).